Liver Injury Grading

Forman, Dana; Jackson, La Scienya M.; Davis, James W.; Garau, Javier; O’Dwyer, David N.; Vedes, Elisa; Abuella, Gihan; Cecconi, Maurizio; Greller, Howard A.; McNutt, Michelle K.; Kozar, Rosemary A.; Cerdá, Jorge; Davenport, Andrew; Dhand, Abhay; Wormser, Gary P.

doi:10.1007/978-3-642-00418-6_443

Cited by 1 publication

(1 citation statement)

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“…As a rule of thumb, grade I and II injuries are considered minor, grade III is moderate, and grade IV and V are severe injuries. The exact definition of each grade is provided below 15 : Grade I: capsular tear/laceration < 1 cm of parenchymal depth or a subcapsular hematoma < 10% of the spleen surface area. Grade II: capsular tear/laceration 1 cm to 3 cm of parenchymal depth or a subcapsular hematoma 10% to 50% of the spleen surface area and < 5 cm in diameter. Grade III: capsular tear/laceration > 3 cm or involving the trabecular vessels or a subcapsular hematoma > 50% of the spleen surface area; a ruptured subcapsular/parenchymal hematoma or a hematoma > 5 cm. Grade IV: segmental or hilar vascular injury that produces devascularization of > 25% of the spleen. Grade V: completely shattered spleen or hilar injury that produces devascularization of the entire spleen. …”

Section: Introductionmentioning

confidence: 99%

Non-operative management of high-grade splenic injury: a systematic review protocol

Nann,

Clarke,

Jog

et al. 2023

JBI Evidence Synthesis

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Objective: The objective of this review is to establish whether embolization is more effective than clinical observation for adult patients with grade III–V splenic injuries. Findings will be used to guide future practice and, if necessary, inform future research design and conduct. Introduction: The spleen is one of the most frequently injured intra-abdominal organs, with a reported adult mortality of 7% to 18% following trauma. Non-operative management has become a standard of care for hemodynamically stable patients. In clinical practice, the decision whether to prophylactically embolize or manage high-grade injuries with observation alone remains controversial. Inclusion criteria: Sources including adult patients with grade III–V splenic injuries secondary to blunt trauma will be included in this review. Eligible studies must include comparisons between 2 cohorts of patients undergoing either prophylactic embolization or clinical observation only. Outcomes will include mortality rate, failure of treatment, intensive care unit admission, length-of-hospital stay, blood transfusion requirements, and patient satisfaction. Methods: A systematic review with meta-analysis will be conducted. PubMed, Embase, and CINAHL will be searched for eligible studies, as will trial registries and sources of gray literature. Study selection, quality appraisal, and outcome data extraction will be performed in duplicate. Methodological quality will be evaluated with appropriate JBI critical appraisal tools. Studies will, where possible, be pooled in statistical meta-analysis. A random effects model will be used and statistical analysis will be performed. The certainty of the findings will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Review registration: PROSPERO CRD42023420220

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